Whether the environment is a small community hospital or a multi-facility enterprise, the PACS administrator’s responsibilities are the same.

For the successful management of an enterprise picture archiving and communications system (PACS), regardless of how large or small an organization is, specific roles and responsibilities directly related to the job description are required of the PACS administrator (PA). Understanding the many hats that the PA must wear within an organization is a key factor in determining the skills required not only for a successful administrator, but also for a progressively growing PACS that meets the needs of the organization.

The size of the organization impacts the number of team members required for PACS management. Other factors to consider include annual examination volumes, the number of enterprise stakeholder customers, and the number of facilities requiring 24/7 coverage. Small institutions producing examination volumes of 100,000 or less might be likely to combine a PACS/radiology information system (RIS) management position; however, organizations with much higher examination volumes are likely to have two distinct, dedicated positions. Additional team members can be recruited from both the technologist and technical ranks to perform in the capacity of analysts and coordinators. Furthermore, the cross-training among team members drawn from both disciplines provides support efficiencies, especially beneficial for 24/7 on-call support. Be advised that a high annual procedural volume and large PACS core team could pose management challenges for the less-experienced PA.

Strong skills in project management, especially written, interpersonal, and organizational communications, are required of the PA. This individual is constantly working with and supporting all stakeholders within and outside the realm of radiology. Whether the problem is supporting a physician across town who is experiencing image access or viewing problems with the PACS, or the task is bringing a new modality online to PACS, strong communications are a must for successful PACS management. Last but not least, the successful PA should possess a profound understanding of radiology workflow.

Wearing Many Hats

The PA takes on many tasks and roles, including redesigning the radiology workflow, which requires excellent project management, organizational, and communication skills.

Workflow redesign is a commonly performed initiative of the PA, whether during a PACS implementation, transitioning from a film-based to filmless environment, or bringing advanced or new imaging technologies online to PACS postimplementation. Early on with a new implementation, the PA must work closely with the modality supervisors to identify the current workflow. The entire life cycle of an examination—including scheduling, performing, reporting, and clinician access—must be understood before any reengineering or redesigning of workflow processes can occur.

Workflow redesign can be an arduous process, more so for the PA than the modality supervisor; the process challenges the project management skills of the PA at all levels. First, the PA must perform an accurate assessment of the current workflow. Although observation is a key component for performing this task, it is not the single most important criterion for the evaluation. The PA also must speak to technologists, schedulers, and support staff, especially from shift to shift, as information can vary from one individual and time of day to another. Communication skills are essential for engaging all team members and stakeholders involved.

Equally important, the PA must demonstrate proficiency in organization to successfully reengineer any workflow. For the redesign process to be successful, the PA must coordinate the training, creation of training materials, documentation, and stakeholder communications surrounding the new redesign.

Once the redesign is successfully piloted and implemented, it is important that the PA possess good interpersonal skills, especially for receiving both positive and negative feedback. The ability of the PA to listen, communicate, and understand all stakeholder questions and concerns will determine whether specific processes need to be revisited or further redesign is warranted. Negotiations for achieving success with the redesign process can involve evaluation and investigation of information potentially not evident or known during the predesign assessment. Strong organizational and personal skills are essential for the engagement and coordination of the diversified resources needed for resolution.

The PA also must coordinate using any suitable forum or venue (eg, meetings or conference calls) to facilitate productive conversations that are conducive to the creative thinking of all team members and will lead to informed, sound decision-making. Commonly, resolution requires modifications either in radiology workflow operations or in PACS configuration or architecture. There will always be team members who are not happy with a process for resolution, but if trust is established as a direct result of the skills of the PA and core team, then stakeholder buy-in and workflow redesign success will be achieved.

Perpetual Training

Training becomes a perpetual responsibility of the PA and is always a requirement for any redesign process or PACS implementation. Once a PACS is implemented, training never stops, and it continues with PACS applications upgrades, the introduction of third-party software programs, and the Band-Aid processes or work-arounds deployed for PACS hardware or software problems. The PA is responsible for modifying vendor training documents for suitable "cheat sheets" as well as creating new training documents altogether.

Even if the PA has core team members available for training across an enterprise, the PA must approve all training materials and manage processes to properly document, archive, and revise such documents. For academic institutions, training becomes a more frequent, regimented event. Moreover, the transience of the trainees creates further challenges; it profoundly attests to the communications and writing skills necessary for successfully training all end users with the PACS. Although training can very easily become a perfunctory task if performed often enough, the depth of motivational and interpersonal skills that the PA and core team members exhibit can be quite advantageous for engaging and successfully inspiring all enterprise stakeholders in learning and using the system.

Day-to-Day Management

Regardless of the size of the enterprise, daily tasks are required in managing every successful PACS. From a radiology operations perspective, PAs must ensure radiology workflow from examination acquisition and reporting through enterprise image access and viewing. Such tasks as health monitoring of the PACS, integrated systems, and interfaces are to be performed frequently throughout the day. Systems checks might be manual, such as checking for inbound and outbound RIS links or visual checks for backlogs in destination or archive queues. Some PACS, however, contain features for automation in health monitoring, producing alerts, such as pager text messaging when certain queues are halted or thresholds exceeded. In the event that a device is halted or the status of a server becomes offline to PACS, the PA can resolve proactively as opposed to reactively. Whether manual or automated, daily monitoring of the PACS by the PA and core team is critical for satisfying workflow efficiencies.

Not only must the PA ensure the constant flow of data within the PACS, but he or she also must work with the radiology operations team to ensure that the data is of good integrity. Such duties as Modality Worklist support, detection and reporting of radiology examinations not archived to PACS, repairing examinations with incorrect status in PACS, and correcting misidentified patient examinations are all responsibilities of the PA and core team. Even if there is adequate participation and sharing of responsibilities on behalf of users and radiology supervisory teams, the PA and core team are responsible for implementing standards for competency-based training, defining roles and privilege levels for users with administrative rights to the PACS, and documenting and tracking all users involved with the manual intervention of radiology examinations residing in the PACS.

In order to perform these duties from a technical perspective, the PA core competencies must include knowledge of the hospital information system (HIS) and RIS, and an understanding of the Health Level 7 (HL7) and Digital Imaging and Communications in Medicine (DICOM) standards. This individual has equally important tasks and responsibilities for ensuring radiology workflow and enterprise image accessibility.

Also, bringing new modalities online to the PACS during and after implementation commonly is an initiative of the PA and core team. Independent of the strong project management skills necessary to coordinate all vendors involved, the PA must exemplify knowledge of the information technology (IT) requirements and perform or manage the necessary requests for cabling, proper network connections, IP addresses, and applications entity titles.

When considering bringing modalities online to PACS from satellite facilities, the PA must ensure that proper networking assessments for bandwidth and transmission speeds are conducted, and that the findings are appropriately managed. Once ready for implementation, a clearly defined testing plan—including both technical and image quality assessments—should be performed with formalized sign-off protocols before the connection is confirmed as acceptable. Additionally, the implementation of and documentation for all end-user training performed before going live to PACS are essential for success.

Even if many or all of these tasks are delegated to additional team members, the PA is ultimately responsible as a project manager for confirming that all technical initiatives, many of which precipitate those that are operational, are performed and managed efficiently and effectively. Whether dealing with the evaluation of future image storage requirements, strategies for determining disaster recovery, or business continuum processes, the PA must either have the technical knowledge required or the resources available for engaging the appropriate technical team members.

Who Wears These Hats?

The PA is responsible for many functions, including both technical and radiology workflow assessments, training, workflow redesign, and modality integration to PACS. Although individuals with either a technologist or technical background are capable of performing the job, the PA also must have strong project management skills, as well as knowledge of radiology workflow and IT processes. The PA must be a driven, motivated individual with an excellent work ethic and the flexibility to adapt to the constant changes associated with emergent technologies and the customer service challenges surrounding enterprise stakeholder support.